May 05, 2017

RINOCare Passes House

On Thursday, the House Republicans just barely managed to pass their bill, the American Health Care Act (AHCA), with 20 Republicans joining Democrats in opposition. After the 217-213 vote, Republican lawmakers and President Donald Trump were crowing in front of the cameras and acting like this was the greatest thing since sliced bread.

In actuality, this is a slight improvement over Obamacare, but far from an actual repeal. It leaves in place certain aspects of Obamacare that contributed greatly to skyrocketing premiums, insurers pulling out of various markets, and a bleak long-term fiscal outlook. Specifically, those include coverage for pre-existing conditions and a series of market-distorting price controls. In short, it leaves way too much government control in place for market forces to be freed up to drive down prices.

The GOP House was paranoid about getting harshly criticized if it went too far in the free market direction, but this was foolish and short-sighted for two reasons: 1) The media and Democrats would hammer Republicans no matter what type of repeal/replace legislation they proposed; and 2) The U.S. Senate will probably write its own bill and not take seriously the House bill. Or if the Senate does try to refashion the House bill, the bill will become unrecognizable.

The Senate probably won't move much in the direction of free market reforms, since that would cause too many Republican defections (think McCain, Graham, Susan Collins, et al). So I am not optimistic about what comes out of the upper chamber in the next few weeks.

There is, however, one cause for faint hope: States will be allowed to apply for waivers enabling them to opt out of the federal program and devise their own healthcare solutions. States often come up with more innovative and creative ways to address problems, and I am cautiously optimistic they will do so with healthcare. Health insurance co-ops, more emphasis on often overlooked alternative medicine, and greater availability of low premium, catastrophic coverage plans are among the promising possibilities.

In short, I have little confidence that Uncle Sam will come up with a comprehensive fix to our tangled, byzantine, bloated and inefficient health care morass. States, being the laboratories of democracy they are, will experiment and tweak with various approaches, and gradually, we may see better quality care, stabilizing prices, less waste and fraud, and fewer uninsured. But make no mistake, it will be a long, torturous slog.